The present invention relates to laser surgery apparatus and, more specifically, to a fiber optic delivery system and handpiece for use in contact laser surgery ("contact" and "contact laser" are trademarks of the Applicant, Surgical Laser Technologies, Inc.).
Contact laser surgery has been known for several years. Typically, a source of laser energy, for example Nd:Yag, is coupled to an optical fiber having a sapphire or similar contact member affixed to the distal end thereof. Examples of contact members adapted for several surgical procedures include U.S. Pat. Nos. B1 4,592,353; 4,693,244; and 4,736,743. Examples of a disposable optical fiber delivery suitable for use with the above noted contact members and with the adjustable touch control handpiece of the present invention include U.S. Pat. Nos. 4,785,805 and 4,895,145.
Contact laser surgery has been highly successful in connection with numerous surgical procedures, both internal and external. The present adjustable touch control handpiece is intended principally for external and such other procedures permitting handheld scalpel manipulation.
Conventional handpieces for contact laser surgery typically consist of a tubular member affixed to a handle. A contact member is rigidly retained on the distal end of the tubular member with the optical fiber being routed through the center thereof. In this manner a surgical hand instrument is defined which provides means for physically grasping the relatively small contact member while protecting the fiber optically connected thereto.
It will be appreciated that a laser scalpel has no intrinsic cutting capability, that is, in the absence of an appropriate source of laser energy. (This is in contrast to the steel-edged counterpart with its ever-present knife edge.) In fact, proper operation requires the modulation of the laser energy whereby the laser energy can be interrupted at all times except during the actual incision process.
As a consequence, the surgeon must be provided with an efficacious and instantaneous means for cycling the laser in response to surgical requirements--a means which must at the same time be consistent with the surgeon's substantially full-time attention to the procedure at hand. Foot switches have been used for this purpose.
The present handpiece incorporates an improved means for laser actuation wherein a "touch control" button is positioned on the handpiece generally at the precise location where the handpiece would be grasped during use. In this manner the surgeon may, on-demand and without need for diverting attention from delicate on-going surgical manipulations, call for laser power.
Implementation of the touch control feature presents special problems with respect to the possibility of electrical shock to patients undergoing surgery. Specifically, the touch control feature has been achieved through the use of a totally self-contained touch detection circuit which contains its own source of extremely low voltage energy. In this manner, all possibility for the generation of damaging or lethal electrical currents is eliminated.
This self-contained touch control circuit generates an actuation signal which, in turn, is transmitted to and actuates the laser upon depression of the touch control button. Again, to maintain complete safety against shock hazard, the touch control signal is communicated to the laser utilizing an optical coupler that transmits the signal as "light energy" thereby avoiding direct wire connections.
Another important feature of the present handpiece is its adjustability along and about multiple axes. This feature is particularly advantageous where, as herein described, a touch laser control is provided thereon. As a consequence of this control, the surgeon has only limited flexibility with respect to where and how the handpiece is held--it must be held such that touch button access can be maintained. By contrast, where a footswitch is employed for laser actuation, the surgeon may "choke up" or otherwise grasp the handpiece in any convenient manner.
Thus, as a first degree of adjustability the present handpiece provides for movement along the longitudinal axis whereby the spacing of the surgical laser contact member from the handle portion of the handpiece may be varied as required by the surgeon for his special preferences and for the operative procedure to be performed.
A second or torsional adjustment feature is also provided whereby the angular orientation of the contact member may be varied with respect to the handle with touch control button therein. This adjustment serves two important purposes particularly with respect to the offset style handpiece in which the tubular member is bent and angled outwardly from the instrument longitudinal axis.
First, the surgeon may adjust the relative angular relationship between the contact member and the touch control button thereby positioning the touch button in a more comfortable and easier to access orientation. The second purpose relates to the neutralization of torsional forces which invariably arise by reason of fiber twisting. This twisting results in the presence of an angular bias on the handpiece which is, at a minimum, distracting and uncomfortable. The present invention permits either the manual or automatic cancellation of such torsional forces.
As will become apparent from the detailed description of the preferred embodiment, additional features and advantages of the present handpiece were implemented in combination with and to augment the above-described adjustment and touch control objectives hereof.
For example, as the touch control button must, of functional necessity, be situated on the handle portion of the handpiece, an arrangement to provide for the electrical connection to the touch control switch was required. This arrangement includes a predetermined multiple turn, helically wound fine-wire coil whereby the full longitudinal and rotational movement discussed above can be effected without wire damage or unusual fatigue.
Another feature associated with the above-described adjustment mechanism includes a longitudinally ribbed handle and pin stop arrangement whereby substantially full 360 degree rotational and axial adjustment is realized without damage to the electrical interconnection wiring of the touch control button.
Forming another important aspect of the present system is its adjustment lock in which a particular rotational and longitudinal relationship between the handle and laser scalpel may be set by the surgeon and locked against further movement. This locking mechanism is defined by a slotted collet which coacts with a threaded rear handle member to rigidly grasp and lock the extension tube on which is mounted the scalpel.
These and other features, advantages, and objectives of the present invention will become apparent the figures and specification herein.